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Hum. Reprod. Advance Access published online on October 27, 2005
Human Reproduction, doi:10.1093/humrep/dei302
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received March 7, 2005
Revised June 29, 2005
Accepted August 17, 2005

Article

A comparative randomized trial to assess the impact of oral contraceptive pretreatment on follicular growth and hormone profiles in GnRH antagonist-treated patients

Luk Rombauts 1*, David Healy 1, and Rob J. Norman 2

1 Monash IVF and Department of Obstetrics and Gynecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168
2 Research Centre for Reproductive Health and Repromed, University of Adelaide, The Queen Elizabeth Hospital, First Floor, Maternity Building, 28 Woodville Road, Woodville, SA 5011, Australia

* To whom correspondence should be addressed.
Luk Rombauts, E-mail: lukrombauts{at}hotmail.com


  Abstract

BACKGROUND: This randomized controlled trial was designed to assess the impact of oral contraceptive (OC) scheduling with a GnRH antagonist (ganirelix) regimen on the ovarian response of women undergoing recombinant FSH (rFSH) stimulation for IVF, compared with a non-scheduled ganirelix regimen and a long GnRH agonist (nafarelin) protocol. METHODS: A total of 110 women was treated with an OC and ganirelix, 111 with ganirelix alone and 111 with nafarelin. The OC (containing 30 µg ethinylestradiol/150 µg desogestrel) was taken for 14-28 days and stopped 2 days prior to the start of rFSH treatment. Primary efficiency parameters were the number of cumulus-oocyte complexes (per attempt) and the number of grade 1 or 2 embryos (per attempt). RESULTS: In terms of follicular growth and hormone profiles, the OC-scheduled antagonist regimen mimicked the agonist regimen rather than the (non-scheduled) GnRH antagonist regimen. In the OC-scheduled GnRH antagonist group and the nafarelin group (versus the non-scheduled antagonist group), pituitary suppression was more profound at the start of stimulation (P ≤ 0.001), there was a slower start of follicular growth (P ≤ 0.001), longer stimulation was required (11.7 and 10.3 days respectively versus 9.4; P ≤ 0.001), and more rFSH was used (2667 and 2222 IU versus 1966 IU; P ≤ 0.001). In the three groups, the number of oocytes was similar (13.1, 12.9 and 11.5 respectively; not significant) as well as the number of good quality embryos (5.1, 5.7 and 5.0 respectively; not significant). CONCLUSION: OC treatment prior to the rFSH/ganirelix regimen can be successfully applied to schedule patients, although more days of stimulation and more rFSH are required than with a non-scheduled GnRH antagonist regimen.

Keywords: GnRH agonist/antagonist/ganirelix/IVF/nafarelin/oral contraceptive pretreatment.
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